Chase was named one of the most influential people in Digital Health due to his entrepreneurial success & writing along with luminaries such as Eric Topol, Patrick Soon-Shiong, Vinod Khosla & Elizabeth Holmes. He speaks to & consults with new ventures inside of established companies & high growth startups. Chase is widely published. The book Chase co-authored won the healthcare Book of the Year in in 2014.
Chase has a penchant for making connections between previously disconnected trends and making them understandable and actionable. Chase is in the development stage of a documentary that seeks to make the indecipherable understandable and demonstrate that there is reason for great optimism that a partnership between doc-entrepreneurs and forward-looking clinicians with individuals (fka “patients”) can dramatically out-perform against Quadruple Aim* objectives compared to traditional healthcare orgs.
*The Quadruple Aim is the Triple Aim (improved outcomes & patient experience with lower costs) plus the overlooked 4th Aim — clinician satisfaction critical to improving the current condition where an alarming number of clinicians are overburdened & burnt-out which negatively impacts their lives as well as the individuals they care for.
Chase was the CEO & Co-founder of Avado, which was acquired by and integrated into WebMD and the most widely used healthcare professional site - Medscape.
Before Avado, Chase spent several years outside of healthcare in startups as founder or consulting roles with LiveRez.com, MarketLeader, & WhatCounts. He also played founding & leadership roles in launching two new $1B+ businesses within Microsoft.
Chase is a father, husband & oxygen-fueled mt sport athlete. His 2014 team placed 3rd in their division & 24th overall (out of 500 teams) in America's oldest adventure race (7 legs -- XC ski, downhill ski, run, road bike, canoe, mt. bike & sea kayak) where Dave took on the Nordic ski leg. Dave was a former PAC-10 800 Meter competitor.

Healthcare's Trillion-Dollar Disruption

As a healthtech startup, you can’t help but get excited when Bob Kocher (Venrock) or Esther Dyson speak about the opportunities in healthcare given their impressive track records. Both spoke during this past week’s StartUp Health Summit.

The same is true politically. There are those who call themselves “progressive” or “conservative.” Unfortunately, it seems that 80 percent of politicos are actually preservatives just doing the bidding of lobbyists trying to protect the status quo. The preservatives are costing thousands of lives and hundreds of billions of unnecessary wasted dollars. The real leaders in healthcare will see through them and get them out of the way of progress.

Healthcare innovators are already redefining healthcare value, putting patients first and inventing with little regard for current constraints. They have ignited a powerful, self-funding upward spiral by focusing first on healthcare’s big opportunities, transforming the value equation, generating large savings, and fueling smart reinvestment in the next wave of innovation. [Introduction, "The Volume-to-Value Revolution"]

Consumerization Of Healthcare

The consumer empowerment taken for granted from everything from buying cars to planning travel is finally arriving in healthcare nearly 15 years later than most industries.

Consumers, long passive, will have a new role. Employer incentives, retail access, and new technology options will encourage them to engage, demand information, and push for value. Baby boomers reaching the age of peak healthcare need will kindle the fire and Millennials focused on nutrition and fitness will keep it burning. The industry’s metamorphosis from a supply-driven market to a more dynamic one driven by demand will happen more quickly and erratically than we expect. Inevitably, mental models will lag behind market reality, and conventional organizations will fight a rearguard battle, hampered by collapsing margins and eroding market share. [Introduction, "The Volume-to-Value Revolution"]

By 2014, as many as 85 million consumers with $600 billion in purchasing power may be shopping for their own healthcare on public and private exchanges. Many will be making their own decisions about coverage for the first time. Consumers will shop not just for insurance, but also for their preferred population-health manager and standalone services, such as basic procedures and retail clinics. [pg. 18, "The Volume-to-Value Revolution"]

One of the reasons providers are choosing cloud-based systems over on-premise software is the resource-intensive deployments required with legacy systems. We’ve seen a small clinic get their cloud-based system fully setup and ready to use in 30 minutes without any onsite people. In contrast, in that same amount of time, one might be able to order the server that gets shipped to that clinic. They will then require onsite installers, trainers, etc. and have a dramatically higher cost base to run that system.

For entirely rational reasons, those older systems were optimized for internal workflows and maximizing billing since that is what has been rewarded historically. To think that those traditional systems will then work perfectly well in the ascending “No Outcome, No Income” era borders on delusional. The reality is hitting right away. A recent article in a HIMSS publication quoted a leading thinker in healthIT, Shahid Shah, outlining 9 major gaps in existing EHRs. He listed “sophisticated patient relationship management (PRM)” as the first major gap. It’s my opinion that as integral as EHRs have been to fee-for-service, PRM will be to fee-for-value. The old model relegated patient portal functionality to be little more than a marketing checkbox. In the new model, PRM functionality becomes a linchpin. In other words, patient portals have been like pre-GoogleGoogle web search (low value afterthoughts on web portals). As Google demonstrated, with the right circumstances, there was huge value ignored by the established players. Likewise, if PRM is viewed as an afterthought, that will increase the risk to providers during this transformative period. Being flat-footed in a time of great change is extremely risky.

The New York Times reported this past week that the public hospitals are already changing the way they compensate their doctors. The first performance measure they listed was how well patients say their doctors communicate with them. These doctors are used to easy communication in the rest of their life with email, text, Facebook, etc. Suddenly, the hospital IT departments are going to start hearing from doctors asking why they can’t have tools that are as easy to communicate with their patients in the other areas of their life. It’s a rare occurrence to hear a doctor say how user-friendly and patient-focused their EHR is. Of course, it’s about more than just technology. The technology simply enables new models. Despite many doctors’ fears, often the changes are for the better as was mentioned by Dr. Bob Margolis, founder and CEO of HealthCare Partners, and one of the physician leaders who has demonstrated extraordinary outcomes:

Oliver Wyman’s report projects that patient-centered care and the shift to value will eliminate $500 billion in low-value-add activities. One has to be in major denial as a healthcare leader to think that we aren’t entering a deflationary era in healthcare. Just watch Bill Gates’ TED Talk on state budgets if you have any doubts. This is exactly the reason the state of New York has moved aggressively to change care and payment models. While doing that, they recognized new models require new technology and didn’t expect they’d get it from legacy providers. This is why the New York Digital Health Accelerator was established. The good news for proactive health systems is that one can thrive in a deflationary period if they shed old assumptions.

A leader at Virginia Mason in Seattle shared how Starbuck’s pushback on costs caused them to look at their entire care proces:

“90 percent of what the hospital was doing was of no value.” As it turns out, the best way to treat most back pain is with physical therapy. That insight led to new processes, including same-day visits (as opposed to 31-day waits), reduced use of imaging tests and prescription drugs, and the addition of psychological support. Within three months, 94 percent of Starbucks employees with back-pain complaints were back at work within a day.

Even today, many EMR vendors will justify the price tags that reach into the hundreds of millions of dollars on the basis of increased billings. That game is nearly over and those hospitals will be saddled with systems optimized for the old models. This past week there were articles in the New York Times and Washington Post stating that EHRs have “failed”. I’d dispute that. EHRs have done exactly as they were designed — maximize billings. That’s how they are pitched so it should be no surprise that costs haven’t been lowered.

Three Waves Of Disruption

Below, I have excerpted and paraphrased some more of Oliver Wyman’s insights from the Volume-to-Value paper illustrating how each of the three anticipated waves of disruption will shift hundreds of billions of revenue from one set of players to another:

Wave 1: Patient-Centered Care (2010-2016). “If we simply mainstreamed today’s best-in-class models of patient-centered, population-health management, the U.S. health system would eliminate nearly $350 billion of low-value-add activity and shift another $600 billion from provider-centered care models to patient-centered care models.” [...] ”Five percent of Americans account for 45 percent of healthcare spending—$1.2 trillion. These 15 million unhealthy Americans at the top of the healthcare pyramid are at the heart of the near-term healthcare affordability crisis and the unfortunate victims of our fragmented, illness- focused healthcare system.” [pages 5 and 7, "The Volume-to-Value Revolution"]

Wave 2: Consumer Engagement (2014-2020). In Wave 2, another $150 billion in low-value-add activities is squeezed out, while $400 billion of additional value will rotate to the new retail value chain.

Wave 3: The Science Of Prevention (2018-2025). Wave 2 will help Wave 1’s great population managers become even more effective and will devastate provider-centric players who have lagged the market. Wave 3 will make the most highly evolved and adaptive population health managers more powerful and will significantly constrict the Wave 1 players who don’t continue to accelerate innovation.

Big Opportunities Require Big Brains

I once heard someone say, “There’s a lot of big brains working on small problems.” They were commenting on the brainpower working on the 8,000th social media app versus where they should be applying their brains. That is, there are three areas that demand as many big brains as possible — healthcare, education, and energy. As a skier, I often say that healthtech startups are the double black diamond in whiteout conditions of startups: super challenging and exhilarating but not for the faint of heart.

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Superb post. One of the best I have read in terms of identifying the current environment, and the opportunity in the future. As the CEO of a cloud-based healthcare company, we constantly straddle the world as it is, versus the world as it could be. It is easy to dream, but will the customer buy that dream today? What is the cost of bringing innovation to a market which has been slow to change? Will healthcare transform over a long period of time because of the entrenched systems and philosophies, or will some scrappy young companies be able to drive real change more quickly? This is definitely a piece that I will share within my organization.

Great and timely analysis. In all Informedika customer focus group discussions with ACO management and physicians we are observing a major shift going on now away from fee-for-service to rewarding quality outcomes. Not surprisingly, state and even county government helping this by “running out of money” and promoting cost-cutting measures which ultimately means everybody starts fighting for treatment quality provided at the lowest cost.

EMR systems failed by succeeding – these systems were designed to maximize providers billing potential while ultimately helped moving the HC closer to the clinical and financial cliff. Healthcare IT MUST step up now and change the landscape to be able to empower doctors to provide quality of service and this is the only way to continue practicing medicine, even from the business perspective. Chronic disease management is largely missing from EMR. BI, analytic, proactive wellness and preventive medicine – these are the directions fro the new technology. The exchange of the data will come from the tech, not from entrenched EMR solutions designed for exact opposite (build the walls around the data so that physicians cannot easily switch).

It was extremely hard to fight with super-large entrenched vendors in HIT. But the good news: the tide is changing. If your product starts to make sense to doctors – you are in business. My advice to start ups: create a product that appeals directly to physicians, earns them money while promoting quality of care, and create a grass-routes following. Physicians are still at the top and the industry will never be run by bureaucratic measures. It still boils down to the relationship between the doc and the patient.

Many of us outside of the box entrepreneur minded startup CEOs will define true improvement in healthcare, cost savings within mHealth/HIT and most important increase in consumer/patient engagement and overall healthcare experience. I invite networking with like minded folks.

It is time to lead change and improvement in healthcare! #improvehealthcare #mHealth #improveHCAHPS #patientexperience @HCXPINC

I spoke to a number of hospital CIOs and asked them about what made their work challenging .. what made healthcare IT unique? it was mentioned that there are big challenges BUT this [healthcare] is the place where you can really cast your vision from an IT standpoint. This is the place where you have an opportunity to see how far agile development methodology can go. This is the place where you can play with the most advanced technology, or at least think about it.

And as you said .. this is the place where engineering can make a difference. We’re excited to see the growth of this industry.

Healthcare costs are skyrocketing. The #1 expenditure of Medicare is joint replacement. Patients harmed by failed implanted medical devices are ill-served by lawsuits after-the-fact. The healthcare industry has defended status quo by loading the FDA with conflicted panel members, limiting voting rights of patient representatives, eliminating clinical trials and registries. Only the thousands of harmed patients now requiring taxpayers to cover longterm care (since profit was proprietary but accountability was not part of the business plan) is prompting disruption. Are you listening, Congress?